# Naloxone Prescribing Among Long-Term Opioid-Prescribed Patients: Disparities and Opportunities

## TL;DR

This study finds that naloxone, which can reverse opioid overdoses, is rarely prescribed to high-risk patients, with disparities based on race and insurance status.

## Contribution

The study identifies disparities in naloxone co-prescribing and provides a framework for improving its use among high-risk patients.

## Key findings

- Only 1% of patients receiving multiple opioid prescriptions were co-prescribed naloxone.
- Patients with opioid use disorder were significantly more likely to receive naloxone.
- Black and unknown race patients were more likely to receive naloxone, while Hispanic and uninsured patients were less likely.

## Abstract

Introduction: Opioids have a risk for opioid-induced respiratory depression (OIRD) that can be fatal. Naloxone has been proven to reverse opioid effects. However, co-prescribing of naloxone with opioids is underutilized. Through the query of a national outpatient healthcare dataset, the study aims to discern differences in co-prescribing naloxone to provide a framework of education to formulate recommendations on naloxone prescribing.

Methods: A retrospective review of a de-identified, national outpatient healthcare dataset was analyzed for patients with a pain-provoking condition and receipt of ≥3 opioid prescriptions. Demographics, medical history, and prescribing data were used to identify high-risk patients for OIRD along with co-prescribing of naloxone between 2015 and 2021 and analysis between 2022 and 2024.

Results: Among 181,964 patients, 1807 (1%) received a naloxone prescription of the total cohort. Examining co-prescribing for high-risk patients only, 107 (3.3%) were receiving >50 MME/day opioids, 468 (2.6%) were concomitantly prescribed benzodiazepines, and 273 (7.8%) who had opioid use disorder (OUD) history received naloxone prescriptions. Upon logistic regression, the likelihood of naloxone co-prescribing among patients with a history of OUD showed an odds ratio (OR) of 6.63 (95% CI 5.76-7.63; p>0.001), and that among patients concomitantly prescribed benzodiazepines showed an OR of 2.76 (95% CI 2.47-3.09; p>0.001). Hispanic patients (OR 0.87; 95% CI 0.76-0.98; p=0.27) and those uninsured or with unknown insurance (OR 0.65; 95% CI 0.51-0.81; p<0.001) were less likely to receive a naloxone prescription. Black (OR 1.30; 95% CI 1.15-1.47; p>0.001) and unknown race (OR 1.38; 95% CI 1.15-1.66; p=0.001) patients were more likely to receive naloxone prescriptions.

Conclusion: Despite recommendations that high-risk opioid-prescribed patients receive naloxone prescriptions, only a fraction are in receipt. There is variation among patient populations in co-prescribing, leaving opportunities to improve universal precautions that include naloxone co-prescribing to all high-risk patients for OIRD.